Wednesday, October 21, 2009

When to change REs?

I have blogged here before about various frustrations with our RE's clinic. Our physician himself is wonderful--he helped T's daughter conceive each of her two children through IVF and has consistently been voted one of the top physicians in our city--and he is the only RE I know who has actually treated someone I know. BUT we have only seen *him* a sum total of three times . . . all for sit-down consultations. At our current clinic, both the ultrasounds and the IUIs are done by the nurse practitioners. From what I have been told by the office staff, the doctors are busy in the mornings--when these things occur--with IVF retrievals and transfers and other procedures. The doctors do perform the HSGs, but as it happened, I had my HSG on a day when my doctor was out of the office, so one of his partners performed my HSG (way back in mid-January 2009).

Our clinic seems to be quite busy; there are always a lot of people in the waiting area every time I'm there. We have had long waits in the waiting room(s) at all three of our appointments with our actual doctor--including having to reschedule entirely one day when an emergency arose during a procedure--and I have had long waits for many routine monitoring appointments as well.

Long waits alone were not enough to make me change clinics, but after my latest interaction with one of the NPs there, I am giving it some serious consideration. Allow me to explain.

I had to have blood drawn for a beta hCG last Friday afternoon before I could start the current treatment cycle. Nevertheless, the NP who saw me that day (and actually drew my blood) provided my prescriptions for Clo.mid and and gave me the go-ahead to start this treatment cycle. Her reasoning was that because I have now had two periods since my (very early) miscarriage, the odds of the blood test showing I'm pregnant were practically zero. I agreed with her logic and started my meds accordingly on CD 3, this past Sunday.

Monday I received a voicemail message from a different NP simply saying that she had the results of my labs from Friday. After two failed attempts to reach her when I called back, I left her a voicemail asking that she call me again and just leave the test results on my voicemail. (My message identifies me by my full name, so she'd have no doubt that she'd reached the right person.)

She didn't call me back until early this afternoon, at which time she left me a message that my beta hCG was "less than 1"--good, and what was expected--and that this was "good news" because it meant we could "start another treatment cycle." OK up to this point. She then instructed me to call on CD 1 to start the next cycle.

Umm. . . I guess she didn't read my chart. I've already started the next cycle. I've taken three days of medications and am scheduled for my monitoring u/s on Monday.

I found this troubling. Because the NPs are the ones directly managing the care I receive at our clinic, their failure to be informed and up-to-date on what is going with me is concerning. This message is kind-of a little thing, but my concern is that it is an indication of poor communication and a lack of continuity of care.

And in the interest of full disclosure, let me share that I worked as a RN from 1994 to 2001, prior to going to law school. I never worked in a fertility clinic, but I think the concepts of communication and continuity of care are pretty universal in any area of health care.

So what say you, fellow patients? Would this concern you? And if so, would your concern be great enough to change clinics?

And on that note, could anyone in the Phoenix area who is reading this and is currently seeing a RE shoot me an email at sangela71 at yahoo dot com? If we do decide to change clinics, I'd like to get your take on wait times, continuity of care and physicians where you go. (For obvious reasons, I'd prefer not to disclose the name of my RE or clinic on this blog.)

Any feedback would be appreciated. Thanks.


  1. As a former health care worker myself, I agree with your concern over their lack of communication. It's a tough decision whether to change RE's or not. I personally felt (feel) like I'm just a number at my clinic. But, when your choices are limited and RE is a booming business, what can you do?

  2. I am not in your area, but the long waits combined with the lack of doctor interaction and the lack of actually reading your charts before calling would be enough for me....if you have alternatives. I am assuming that in your area, you will have other options.

  3. The first thing I would do would be to talk to the office about your concerns. See what they say.

  4. Hmmm...yes, I think I would also be concerned about the combination of long waits, lack of time with the doctor, and especially the continuity of care issues. There are two ways to look at the rankings and success rates excuse the general lack of trust for you? Or, is trust and open communication more important for you?

    Sorry for the RE drama and concern! :-( Good luck this cycle!


  5. Yes, all of those things combined would definitely concern me. I second Lin's questions, though. Do their success rates override their lack of communication and personal attention? If it were me, I would at least mention my concerns to your RE and see what he says. But if you still don't feel comfortable after that conversation and the problems are ongoing, then it might be time to shop around.

    Good luck!


  6. I should clarify a couple of points that I didn't think about until reading the comments.

    Talking to the office about my concerns is not an option: I tried that back in April, when I experienced my third 2-hour wait. Things didn't really improve, and I didn't feel that the office staff took my complaints very seriously.

    I know enough about physicians to know that talking to my doctor probably won't solve anything. I doubt he involves himself much in the day-to-day running of the office; most doctors in multi-provider practices don't, in my experience.

    Also, success rates are not really an issue for us because we are only doing IUI, with zero intention of ever going further, and none of the clinics I've researched publish success rates for IUI, only for IVF (which we aren't go to do).

  7. I think you have to go with your gut - especially given your background.

  8. honestly, i think i would leave. i don't love my clinic, but at least i get one on one attention from my RE who also happens to be the lead RE for the infertility practice. it makes a big difference in my comfort level.

    but go with your gut, like the poster above noted. you know what's best for you.

  9. I am not in your area, but at my clinic, one nurse manages your cycle and my doctor scheduled the retrieval when he could do it. When he couldn't do it, he talked to me about it beforehand and made sure I was comfortable with someone else. The longs waits combined with the lack of communication would have me questioning whether or not they had my best interest in mind or if I was just another number.


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